Jim: Welcome to Fairfax County’s Medicare Moments, the
podcast that brings you the latest information on Medicare benefits.
I‘m your host, Jim Person. Are you a Medicare beneficiary who is
having trouble paying for deductibles and copayments? Medicare
pays for most of the costs of health care for older adults but there
are still costs it doesn’t pick up and these costs seem to be going
up every year. Joining us today to discuss this is Howard Houghton,
the manager of Fairfax County’s Virginia Insurance Counseling and
Assistance Program. Welcome, Howard.

Howard: Thanks, Jim. Good to be here again.

Jim: Howard, let’s start with an explanation of
Medicare’s so called out-of-pocket costs.

Medicare A is for hospital insurance and other inpatient expenses,
Medicare B is for doctor costs and other outpatient services,
Medicare C is for Medicare Advantage programs, and Medicare D is for
prescription drugs.

It is important to remember that Medicare does not pay for all
costs. Out-of-pocket costs refer to deductibles and coinsurance
amounts as well as the monthly premium that Medicare B beneficiaries
pay.

Jim: OK – it’s my understanding that these
out-of-pocket costs have really soared over the years and that some
people are having problems paying them.

Howard: Yes, that’s true, Jim. Economists and policy
experts have pointed to the fact that increases in health care costs
are outpacing increases in retirement income. This means that
Medicare beneficiaries are paying more in out-of-pocket costs for the
same services.

Jim: I’m guessing people with lower income are facing
the greatest difficulties.

Howard: Absolutely.

Jim: So, what should a Medicare beneficiary who is
having difficulty keeping up with out-of-pocket costs do?

Howard: What they should do is look into programs that help
pay for the out-of-pocket costs. As you can imagine, they have rather
bureaucratic names:

the first is called the Qualified Medicare Beneficiary program or
QMB;

the second program is called the Specified Low-Income Medicare
Beneficiary or SLMB;

and the third is the Qualified Individual 1 program or QI-1.

These programs are funded by the feds and the state. They all pay
for Medicare out-of-pocket costs for people who are eligible,
including costs associated with the Medicare drug programs.

Jim: Are these programs the same as Medicaid.

Howard: Yes and No. It can get a bit confusing because
you do need to apply for these programs through the state Medicaid
program but must also have Medicare. I think of them as a hybrid
programs.

Medicaid is for people who have even lower incomes than those
who qualify for the QMB, SLMB and QI-1 programs. In Virginia, you
cannot have more than 80% of the federal poverty limits. These
amounts change each year so folks will need to check online for the
current federal poverty limits (FPL). So, when looking into these
programs, it is a good idea to determine whether you are eligible for
Medicaid as well.

Jim: And if you qualify for Medicaid?

Howard: Then Medicaid, the health insurance for the
poor, will pay for costs that Medicare does not cover. People
who have Medicare and Medicaid are called being dually-eligible.

Again, QMB, SLMB and QI-1 are for people with Medicare who do not
qualify for Medicaid but need help paying for Medicare
out-of-pocket costs because they have a low income.

Jim: OK, I think I get it. So, tell me about QMB, who
is eligible and what does it cover?

Howard: To be eligible for QMB a person must make no
more than 100% of the federal poverty limits. QMB pays
for Part A and B deductibles, co-insurance amounts and Part B
premiums.

Jim: And SLMB, who’s eligible and what does it cover?

Howard: People who make less than 120% of the
federal poverty limits are eligible. If eligible, it covers the Part
B premiums only.

The QI-1 program has essentially the same benefits as SLMB. The
difference is that you can have a bit more money each month, up to
135% of the federal poverty guidelines. The main difference
between SLMB and QI-1 is that once the funding for QI-1 is exhausted,
no more applications are taken that year. Fortunately, the program
has never run out of funds…so far.

Jim: I know a lot of social programs have resource
limits. Do these programs also have resource limits?

Howard: Yes they do. These programs require you have
less than $7,080 for a single person and $10,620 fora married couple
in liquid resources such as cash and bonds. The house you live in and
a car do not count. Again, these figures change with time so
persons need to check the annual federal poverty income/asset
guidelines to be certain about potential eligibility.

Jim: Wow, Howard, my mind is swimming with way too many
acronyms and dollar amounts. Who can our listeners call to get more
information about these programs and determine whether they should
apply?

Howard: To get more information about applying for QMB,
SLMB, QI-1 and Medicaid, they should call the Department of Family
Services at 703-324-7500. If a person is eligible for any of these
programs they will automatically receive some help towards paying
their Medicare drug plans costs too. Also, www.Medicare.gov has information
about both of these programs.

Jim: Well, there you have it. Again, for more
information about the programs that help pay for Medicare’s
out-of-pocket costs, call 703-324-7500, TTY 711. As always, call the
Virginia Insurance Counseling and Assistance Program if you encounter
a problem with Medicare or need advice choosing a plan. The number is
703-324-5851, TTY 711.

I want to thank our guest, Howard Houghton for talking to us about
the ins and outs of Medicare and I want to thank our listeners for
tuning into our show today. Until next time, this is Jim Person
with Fairfax County’s Medicare Moments.